Infertility: 5 causes we see most often

Five causes sit behind the great majority of couples who do not conceive. Two of them are treatable with weight and tablets, one needs a procedure, one needs a specialist quickly, and one is a clock — which is exactly why the diagnosis comes before the remedy.

The definition first, because it decides when to act: twelve months of regular unprotected intercourse without conception if the woman is under thirty-five, six months if she is thirty-five or older. Waiting quietly beyond that is the most common and most costly thing we see.

Cause 1: ovulation that is irregular or absent

The most frequent single cause, and most often part of PCOS. The tell is cycles longer than thirty-five days, fewer than eight periods a year, or no predictable pattern at all — with acne, extra hair, weight around the waist, or a previous thyroid or prolactin problem.

It is also the most treatable: weight loss of even five to ten percent restores ovulation in a large share of women with PCOS, insulin resistance is addressed properly, and ovulation-induction medicines are prescribed and monitored by a fertility specialist rather than bought. Two blood tests and a scan usually confirm the pattern; thyroid and prolactin get corrected by whoever treats those, because both stop ovulation.

Cause 2: the tubes, usually from an infection nobody finished treating

Fallopian tubes are blocked or damaged by pelvic infection — often after a sexually transmitted infection that was never diagnosed, sometimes after a terminated pregnancy, an appendicitis that burst, or tuberculosis, which is not rare here and produces no symptoms at all until it does.

A blocked tube is not treated with a decoction, and no herbal course opens one. The test is an X-ray dye study or a laparoscopy, and the treatment is either surgery or IVF. This is the cause where months of self-treatment cost the most, because the delay is invisible.

Cause 3: the male factor, which is half the picture

Low count, poor motility, abnormal shape, or a varicocele contributes to roughly half of all cases, and it is the cheapest cause to investigate: two semen analyses three months apart and a physician's examination. Untreated diabetes, smoking, obesity, heat, testosterone injections bought at a gym and unlabeled "power" supplements all damage production.

Testing the woman alone while the man is not examined is a genuine and very common error in India. It costs couples years.

Cause 4: endometriosis and uterine problems

Severe period pain that has worsened over the years, pain with intercourse or bowel movements, heavy bleeding with clots, and a normal scan — that pattern is endometriosis until proven otherwise, and it damages fertility by inflammation and by adhesions rather than by blocking ovulation. Fibroids, polyps and a thin lining sit in the same group, and each is diagnosed by ultrasound or hysteroscopy.

Pain that has been normalised as "just my periods" is the reason this cause is diagnosed late. It deserves a gynaecologist's opinion, and often laparoscopy, before anyone calls a couple unexplained.

Cause 5: age, ovarian reserve and the whole-body context

Egg number and quality fall with a woman's years, sharply after thirty-five and steeply after forty; that is biology and not a moral statement, but it changes the timeline for everything else. Weight at either extreme, smoking, alcohol, uncontrolled sugar, thyroid and prolactin problems, untreated celiac disease, severe stress and sleep loss all sit underneath the five causes and are worth correcting whatever else is found.

What ayurvedic treatment can honestly do here

It belongs in three lanes: the metabolic and cycle picture of PCOS — insulin, weight, inflammation, sleep and the bowel, with a formulation chosen for that woman and reviewed after a complete cycle; the support and side-effect management around fertility treatment, where many women use both and should tell each doctor what the other has prescribed; and the sexual and hormonal function of the man. It does not belong in front of a blocked tube, severe male-factor infertility, a fibroid distorting the cavity, or diminished ovarian reserve, where the effective answer is a specialist's procedure and the honest consultation says so in the first sitting.

Nobody should be given a promise of conception in a fixed number of days. Any clinic or packet that makes one is describing something that cannot be guaranteed for any patient.

Get assessed rather than supplemented

• Twelve months of trying under thirty-five, six months at thirty-five or above.
• Cycles longer than thirty-five days, absent, or fewer than eight a year.
• Known pelvic infection, tuberculosis, surgery, endometriosis, or two or more miscarriages.
• Testicular problems, undescended testicle, chemotherapy, or prior mumps after puberty in the man.
• Any couple where one partner has been treated for years and the other has never been examined.
• Pain that prevents normal intercourse, or ejaculation that does not occur.
• A woman over forty who is trying now — the assessment should be immediate, not after a year.

How an Aksa consultation handles this

The couple is taken as one case: both partners examined, the baseline bloods and two semen analyses, a scan for the uterus and ovaries, and the tubal test when the picture suggests it, with referral to a fertility specialist made in the same visit where findings demand it. Where treatment is indicated it is given or referred for, and classical support is used for the pattern around it, dosed and reviewed rather than left running indefinitely. Aksa physicians have consulted on reproductive cases since 1992. A video consultation is free and private, and where examination or scans are needed we see people at our two clinics in Delhi, Model Town and Burari.

None of this is a prescription. In pregnancy planning, on other treatment, or after any fertility medication has been taken, confirm every addition with a qualified doctor.

If it has been a year — or six months past thirty-five — book both partners an appointment in the same week. The five causes above are diagnosed with tests, not with time, and the fastest route to a baby is usually the one that starts with a report.